PROJECT SUMMARY/ABSTRACT Fecal Incontinence (FI) is a debilitating condition that affects up to 17% of community-dwelling adults age 65 and older and is a leading cause of worse quality of life, caregiver fatigue and institutionalization in older women. There is a lack of safe and effective conservative treatments for fecal incontinence in older women. Epidemiological studies show that fecal incontinence in older adults is closely associated with diarrhea and fecal urgency, Recent studies show that the composition of the diet influences the level of bile acids and short-chain fatty acids in the stool, key metabolites that modulate gut motility and consistency of stool. These findings suggest that dietary modifications could significantly improve fecal incontinence in older women. While empirical dietary modifications are often recommended for women with FI there is a key gap in knowledge of specific interventions targeted to older women with FI. In this project, using a mixed methodology approach, we plan to: 1) develop a diet modification program for treating older women with fecal incontinence; 2) estimate the clinical effectiveness of the diet modification program in older women with FI. In addition, we plan to explore mechanisms through which a diet modification program improves FI by examining stool samples for specific metabolites?bile acids and short chain fatty acids. The proposed project is innovative because we plan to develop a diet modification program specifically tailored to older women and will do so using patient input. Measurement of stool metabolites will expand our understanding of mechanisms by which diet affects FI. The proposed project fills a tremendous gap in FI research and will provide older women with a safe and effective option to manage a debilitating condition. The project is feasible as it builds upon the PIs current research expertise and will be guided by a team of mentors with expertise in aging and mixed methodology research. Successful completion of the project will also launch the PIs career in aging related research in pelvic floor disorders.